Leadership Oklahoma City Signature Class 38 Tackles Health and Medical Services Day

Yesterday, Leadership Oklahoma City, Inc. (LOKC) orchestrated another valuable day of learning and engagement. In partnership with LOKC, SSM Health St. Anthony Hospital, Variety Care, and The Children's Hospital at OU Medicine each hosted us for Health and Medical Services Day. #weleadokc

Joe Hodges, Regional President, Hospital Operations, SSM Health of Oklahoma welcomed us in the Sr. Mary Jean Ryan Conference Center. He confirmed SSM Health of Oklahoma seeks to assist rural hospitals and explained some of the complexities associated with these partnerships due to each rural hospital being organized differently (e.g., private v. public). He also shared their efforts in partnering with food banks.

Susan Relland, Senior Vice President and Chief Administrative Officer, American Fidelity, provided us with an overview of the health and medical services landscape. Health care is expensive (even with employees only paying 15% to 20% of the total cost of their health care premiums), there’s a significant number of uninsured, quality of care is questionable, and access to care is limited (e.g., in rural areas). Some cost drivers include having to pay medical providers to do more (e.g., doctors run every possible test to mitigate threat of being sued for medical malpractice—“leave no stone unturned” mentality), our population is growing older and fatter, the entity paying isn't in the room, and some doctors aren’t aware of how much prescriptions cost (e.g., When prescribing acne medicine, the doctor checked no generic medication available. When the patient went to the pharmacy and learned it cost $950 per month, the patient called the doctor, and the doctor said, “Oh, I didn't realize it costs that much” and then wrote a prescription for a cheaper, yet comparable drug).

Kevin Corbett, CEO of the Oklahoma Health Care Authority (OHCA), began with definitions: Medicare is the social insurance program for the elderly, and Medicaid is the needs-based social welfare program. Medicaid is a $600 billion industry where the federal government pays 61%, and the state pays 39%. The OHCA is Oklahoma's agency dedicated to serving our citizens enrolled in the Medicaid program (branded as SoonerCare): 26% of Oklahoma County (more than 206,000 lives represented by 1 in 4 Oklahomans and 3 in 5 children), including children under 19, children in foster care, pregnant women, the blind, the disabled, and women with breast or cervical cancer. To be eligible, a family of 4 can earn a maximum income of $4,507 per month, and each member costs $12,200 per year to serve.

Lou Carmichael, CEO of Variety Care, reported 450,000 Oklahomans lack basic health insurance. Being uninsured leads to higher costs by the time these individuals reach the eligible age for Medicare because medical issues that could’ve been addressed with primary care go unattended due to an inability to pay: 38% of the population are uninsured or underinsured, 30% of children live in poverty, and 84% of the students in Oklahoma City Public School are economically disadvantaged. Oklahoma has the highest divorce rate in the U.S., the highest teen birth rate in the world, and is in the Top 7 for HIV. Oklahoma also ranks highest in the nation for a score of 3 or more on the ACE (adverse childhood experiences) test, an indicator significantly correlated to youth having health issues as adults. Americans spend more to die earlier than the rest of the world. Whereas the Affordable Care Act’s strategy was to increase access (not to decrease cost), the goal should’ve been and should be to improve individual health. As such, Variety Care targets areas with dense poverty, providing value-based care to more than 120,000 patients in 2017.

Terri White, Commissioner for the Oklahoma Department of Mental Health and Substance Abuse..., espoused that mental health is public health because mental illness is a chemical disease of the brain—the same as diabetes is a disease of the pancreas. In Oklahoma, more than 700,000 (21% of the population) have reported mental illnesses, yet only 1 in 3 have access to needed medical services. This point is key because untreated diseases are progressive. In Oklahoma County, more than 112,000 adults experienced mental illness, and only approximately 19,000 received services. The highest contributors to mental illnesses are marijuana, methamphetamines, and alcohol. Half of mental illnesses occur by age 14, and 3/4 of mental illnesses occur by age 24. In 1981, Nancy Reagan's message, “This is your brain. This is your brain on drugs.” was attributed to a decrease in the use of drugs, because it highlighted the dangers of addiction as opposed to opioids and marijuana, which are being advertised as medicine. The average age of the first use of alcohol among Oklahoma youth is 13. If a person begins drinking before the age of 14, it is 45% more likely that the person will become an alcoholic. If the person begins drinking at the age of 21 or later, a person is 10% likely to become an alcoholic. Of the people who seek treatment for alcohol addiction, more than 85% began drinking before the age of 18. The deaths of despair include drug overdose, suicide, and liver disease (due to alcohol). Oklahoma is one of only 7 states where deaths surpassed 200 per 100,000 residents due to binge drinking. Binge drinking for women is considered 4 or more drinks during one occasion and 5 or more drinks per occasion for men. In Oklahoma, 1 in 10 adults report being binge drinkers. In terms of costs, Drug Court costs $5,000 per individual annually whereas incarceration costs $19,000 per individual annually. For graduates of Drug Court, there is a 96% drop in unemployment, a 134% increase in monthly income, a 109% increase in access to private health insurance, and a 90% increase in regaining the custody of their children. Said differently, between FY10 and FY12, there were approximately 4,000 graduates who collectively earned $204 million in income and paid $6.1 million in taxes. Had those graduates been incarcerated, Oklahoma would’ve paid $193 million.

Marshall Snipes, CEO of AmeriClaims, Inc., began with his four takeaways. First, health care is too expensive and isn’t sustainable. As a percentage of GDP in 2018, health care costs were 18.2% and increasing whereas all other developed countries were spending approximately 11% of their GDP. The United States spent more than $3.6 trillion last year with less than half of that amount going to doctors and hospitals (who deliver the services). Some trends driving up costs follow: poor health choices (71% of the nation is overweight or obese), social determinants, lack of access to primary health care, entity paying for health care services is not who decides to consume services, opioids, prescription drugs, population living longer, innovations in health care (the only industry where innovations lead to increased costs), uncoordinated information systems, high administrative costs, medical variations or lack of evidence-based medical practices, a fee for service model instead of a fee for value model, end of life decisions (most expensive decisions occurring during the last 6 months of a loved one’s life; Americans have a hard time coming to grips with dying). Second, we don't get reasonable rate of return for the money that we spend in health care. The United States is 26 out of 30 OECD countries in outcomes. The U.S. spends twice per capita than other developed countries. Oklahoma is 47 of the 50 states. Third, the health care debate has been about who pays for health insurance instead of being about the health status or care of individuals. Fourth, legislation without reform will not solve the problem. We need an integrated care system, we need to maximize the use of federal dollars, we need access to health care in rural areas, we need to coordinate health care with providers who address social determinants and mental illness, we need to increase health literacy in Oklahoma, we need to increase government efficiency, and we need to define and measure success.